Provider Demographics
NPI:1558782862
Name:RAUCCI, LAURA L (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:RAUCCI
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 HAWTHORNE TER
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1119
Mailing Address - Country:US
Mailing Address - Phone:551-404-3542
Mailing Address - Fax:
Practice Address - Street 1:78 HAWTHORNE TER
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-1119
Practice Address - Country:US
Practice Address - Phone:551-404-3542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-05
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054332001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical